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Journal of Veterinary Pharmacology and... Apr 2018The objective of this review was to perform a literature compilation of all the equine publications that used dexmedetomidine as the first article on this topic was... (Review)
Review
The objective of this review was to perform a literature compilation of all the equine publications that used dexmedetomidine as the first article on this topic was published, in 2005. We also aimed to answer the question whether the use of dexmedetomidine can currently be justified. For that, we compiled information from databases, such as PubMed, Google Scholar and Web of Science and the proceedings of the last veterinary anaesthesiology meetings. Dexmedetomidine is an attractive drug to be used in horses, mainly due to its pharmacokinetic profile and pharmacodynamics that favour its use as intravenous constant rate infusion (CRI). Nowadays, its clinical use is popular for sedation in prolonged standing procedures and during partial intravenous anaesthesia (PIVA) and total intravenous anaesthesia (TIVA). However, legal requirements for its use should be taken into account.
Topics: Analgesia; Anesthesia; Animals; Dexmedetomidine; Horses; Hypnotics and Sedatives
PubMed: 29226340
DOI: 10.1111/jvp.12474 -
Journal of Advanced Nursing Dec 2020To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour. (Review)
Review
AIMS
To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour.
DESIGN
Mixed-methods systematic review.
DATA SOURCES
A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected.
RESULTS
Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent.
REVIEW METHODS
Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE-CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed-methods synthesized findings was produced.
CONCLUSION
Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth.
IMPACT
The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision-making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high-income countries.
Topics: Analgesia, Epidural; Female; Health Personnel; Humans; Labor, Obstetric; Pain Management; Parturition; Pregnancy
PubMed: 32989801
DOI: 10.1111/jan.14555 -
Pain Physician Jul 2016Offset analgesia (OA) is an increasingly described phenomenon to measure endogenous pain inhibition, in which a greater decrease in pain intensity is experienced than... (Review)
Review
BACKGROUND
Offset analgesia (OA) is an increasingly described phenomenon to measure endogenous pain inhibition, in which a greater decrease in pain intensity is experienced than would be predicted by the decrease in painful stimulation. The temporal filtering in this OA phenomenon differs from the spatial filtering in the commonly described conditioned pain modulation (CPM). Yet, the knowledge on the efficacy of OA in chronic pain patients is scarce, compared to CPM efficacy.
OBJECTIVE
This systematic review has been conducted to provide an overview of the current knowledge regarding OA, and to compare it to CPM.
STUDY DESIGN
A systematic review of research studies that investigated the application or mechanisms of OA.
SETTING
The present study took place at Ghent University and the University of Antwerp.
METHODS
This systematic review follows the PRISMA guidelines. The electronic databases Pubmed and Web of Science were searched in January 2015. Full text clinical reports addressing OA were included. The checklists for randomized controlled trials, case-control studies, and cohort-studies provided by the Dutch Institute for Healthcare Improvement and the Dutch Cochrane Centre were used to assess methodological quality. The articles received a level of evidence A1, A2, B, C, or D, based on study design and risk of bias. These levels were used to determine the strength of conclusion (level 1 to 4).
RESULTS
Seventeen articles met the inclusion criteria. Sixteen studies used quantitative sensory testing to provoke OA; however, differences in protocols are present. OA can function as a non-opioid mediated assessment tool for endogenous pain inhibition, and activates brain regions such as periaqueductal gray (PAG), dorsolateral prefontral cortex, insula, medulla, pons and cerebellum, indicating strong brain derived pain modulation. The primary somatosensory cortex is, conversely, less activated during OA. OA is decreased in neuropathic patients. Nonetheless, evidence for the influence of individual factors on OA is limited. OA and CPM seem to rely on different mechanisms.
LIMITATIONS
Search strategy was taken wide, wherefore a large variety of research perspectives were included.
CONCLUSIONS
This systematic review displays OA as a temporal filtering mechanisms that is more brain-derived compared to the spatial assessment method CPM. There is strong evidence for reduced OA in neuropathic patients, however, evidence regarding OA in (sub)acute and central sensitization patients, and the influence of personal factors on OA is currently scarce and needs further investigation.
Topics: Analgesia; Central Nervous System Sensitization; Chronic Pain; Humans; Pain Management; Pain Measurement
PubMed: 27454261
DOI: No ID Found -
Tumori Feb 2023Several peripheral regional anaesthesia (RA) techniques are commonly used in thoracic surgery even in the absence of precise indications regarding their effectiveness on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several peripheral regional anaesthesia (RA) techniques are commonly used in thoracic surgery even in the absence of precise indications regarding their effectiveness on postoperative pain management.
OBJECTIVE
This systematic review and meta-analysis aims to describe and evaluate the relative effectiveness of different peripheral regional blocks and systemic analgesia in the context of video-assisted thoracoscopic surgery (VATS) or thoracotomy.
DESIGN
Systematic review of randomized controlled clinical trials (RCTs) with meta-analyses.
DATA SOURCES
We searched PubMed and Embase for all RCTs comparing the 24 hour morphine equivalents (MMEs) consumption following peripheral regional blocks and systemic analgesia (SA).
ELIGIBILITY CRITERIA
We selected only RCTs including adult participants undergoing thoracic surgery, including esophagectomy and reporting on postoperative pain outcomes including 24 hour MMEs consumption.
RESULTS
Among the 28 randomized studies including adult participants undergoing thoracic surgery and reporting on 24 hour opioid consumption, 11 reporting a comparison of individual blocks with systemic analgesia were meta-analyzed. RA was effective for almost all peripheral blocks. Regarding intercostal block, its antalgic effect was not well evaluated SMD -1.57 (CI -3.88, 0.73). RA in VATS was more effective in reducing MMEs than thoracotomy SMD -1.10 (CI -1.78, -0.41).
CONCLUSIONS
RA is a useful choice in thoracic surgery. However, it is still not possible to determine the most appropriate block in the individual surgical settings to be performed due to RCTs paucity.
Topics: Adult; Humans; Thoracic Surgery; Nerve Block; Pain Management; Analgesia; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 35361015
DOI: 10.1177/03008916221081891 -
Anaesthesia Apr 2021Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role... (Meta-Analysis)
Meta-Analysis
Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta-analysis evaluated the benefits and risks of intra-articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra-articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24-h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time-to-first analgesic request; patient satisfaction; opioid-related side-effects; block-related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra-articular infiltration reduced 24-h postoperative analgesic consumption by a weighted mean difference (95%CI) of -30.9 ([-38.9 to -22.9]; p < 0.001). Intra-articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (-2.2 cm [(-4.4 to -0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid- or block-related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra-articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery.
Topics: Analgesia; Analgesics, Opioid; Arthroscopy; Brachial Plexus Block; Humans; Injections, Intra-Articular; Morphine; Pain, Postoperative; Shoulder
PubMed: 32596840
DOI: 10.1111/anae.15172 -
Palliative Medicine Sep 2021Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of...
BACKGROUND
Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures.
AIM
To determine whether reported devices impact the outcomes of palliative sedation.
DESIGN
Systematic review and narrative synthesis of research published between January 2000 and December 2020.
DATA SOURCES
Embase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded.
RESULTS
Six reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.
Topics: Adult; Analgesia; Anesthesia; Conscious Sedation; Humans; Hypnotics and Sedatives; Nociception; Palliative Care
PubMed: 34109873
DOI: 10.1177/02692163211022943 -
Journal of Pediatric Nursing 2021Effective pain management is the key to improving not only patient outcomes but also patient satisfaction. Patient controlled analgesia (PCA) is a pain management method...
PROBLEM
Effective pain management is the key to improving not only patient outcomes but also patient satisfaction. Patient controlled analgesia (PCA) is a pain management method that allows the patient to self-administer their medication. Because of the great variety of physical and cognitive abilities in the pediatric population, involvement of a nurse or parent proxy is necessary.
PURPOSE
The purpose of this study was to ascertain the most effective approaches to PCA in pediatric settings.
ELIGIBILITY CRITERIA
Criteria for articles selection were as follows: (a) published in a peer-review journal, (b) between 2014 and 2019, (c) in English, (d) directly addressing the issues of safety and efficacy of patient-controlled analgesia by proxy in the pediatric patient population.
SAMPLE
Databases used in the search included CINAHL Plus with Full Text, DynaMed, MedLine with Full Text, and ScienceDirect. Combinations of the following keywords were used to search each database: "nurse controlled analgesia", "parent controlled analgesia", "patient controlled analgesia by proxy", "NCA", "P/NCA", "PCA by proxy", "pediatrics", "children", "pediatric patients". Database searches yielded 172 results. Articles that were duplicated, missing inclusion criteria or did not directly address the issues of safety and efficacy of PCA by proxy were removed. Eleven articles fit the selection criteria.
RESULTS
Eleven articles were included in the final report. The themes that emerged from the analysis included pain management of neonates and infants, children with developmental disabilities, children with cancer, as well as the sources and possible solutions to errors in medication preparation.
CONCLUSIONS
It was concluded that PCA by proxy remains a safe and efficient method of pain administration for the pediatric population, with the exception of children suffering from developmental and neurological disabilities.
IMPLICATIONS
PCA by proxy, although presenting challenges, remains a safe and efficient way of pain management across different pediatric populations, such as infants and neonates or children with cancer, both inpatient and outpatient, and new technologies could positively influence the safety of this method of pain management. Conversely, children with developmental and neurological disabilities do not benefit from this method of pain management and are more prone to experiencing adverse effects.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Child; Humans; Infant; Infant, Newborn; Pain Management; Pain, Postoperative; Parents; Patient Satisfaction; Pediatrics
PubMed: 34139608
DOI: 10.1016/j.pedn.2021.06.002 -
British Journal of Anaesthesia Jul 2015Epidurals provide excellent analgesia for cardiac surgery and may reduce complications. However, their use has been tempered because of concern of the rare, but serious... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epidurals provide excellent analgesia for cardiac surgery and may reduce complications. However, their use has been tempered because of concern of the rare, but serious complication of epidural haematoma. The aim of this meta-analysis was to assess the effect of epidural on survival and the risk estimate of epidural haematoma.
METHODS
A systematic review of the literature (Pubmed, Embase, Scopus and the Cochrane Register) and a meta-analysis of the available randomized and case-matched studies were performed to estimate the effect on survival. An international, directed and viral anonymous survey was performed to identify the incidence of haematomas with a corresponding estimate of the number of epidurals performed.
RESULTS
Of 66 randomized and case-matched studies, 57 trials including 6383 patients reported the incidence of all-cause mortality at the longest follow up available, with a significant reduction with epidurals (59/3123 [1.9%] vs 108/3260 [3.3%] in the control arm, RR 0.65 [95% CI 0.48-0.86], P=0.003, NNT=70). No epidural haematoma was reported in these 66 trials (3320 epidurals). All other literature revealed nine haematomas in 13,100 patients. Through the anonymous, web-based, viral, international survey, we identified 16 further, non-published, epidural haematomas from 72,400 positioned epidurals. Therefore, a total of 25 haematomas have been identified from an estimate of 88,820 positioned epidurals, producing an estimated risk of 1:3552 (95% CI 1:2552-1:5841).
CONCLUSIONS
The use of epidural analgesia in cardiac surgery is associated with a reduction in mortality (NNT=70), and with an estimated risk of epidural haematoma of 1:3552.
Topics: Analgesia, Epidural; Cardiac Surgical Procedures; Humans; Randomized Controlled Trials as Topic; Risk Assessment; Survival Analysis
PubMed: 26089444
DOI: 10.1093/bja/aev201 -
Journal of Clinical Anesthesia Jun 2020The Quadratus lumborum (QL) block was first reported as a postoperative analgesic technique for abdominoplasty, and since has been used for a variety of surgeries. In... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
The Quadratus lumborum (QL) block was first reported as a postoperative analgesic technique for abdominoplasty, and since has been used for a variety of surgeries. In this systematic review and meta-analysis, we summarize the current literature on the postoperative analgesic effect of QL block.
DESIGN
We systematically searched PubMed, CENTRAL, CINAHL, EMBASE, Clinical Trials Registry (U.S. National Library of Medicine), Web of Science and Google Scholar for randomized control trials. The primary outcome was the comparison of 24-hour opioid requirements between the QL block and systemic analgesia cohorts; secondary outcomes included time to rescue analgesia, postoperative nausea and vomiting, block related complications and comparison between QLB and other regional anesthesia techniques.
MAIN RESULTS
We identified 22 studies for inclusion: 16 studies compared QL block to GA with systemic analgesia, four studies compared the QL block with the TAP block, and the rest on other comparisons (such as femoral block and continuous wound infiltration). QL block significantly reduced the opioid requirement in cesarean deliveries and renal surgeries, there were insufficient studies for the other surgery types. Several studies reported that QLB was associated with significantly reduced pain for up to 24 h postoperatively, but quantitative analysis is not possible due to high heterogeneity. The most common block related complication was local anesthetic toxicity.
CONCLUSIONS
QL block significantly reduces opioid requirement in cesarean delivery and in renal surgery. The evidence for other surgery types are limited. QL block may have analgesic effect for up to 24 h postoperatively, but the evidence is again limited. There is currently limited evidence comparing QL block to other analgesic techniques, further studies are needed in this area.
Topics: Adult; Analgesia; Analgesics, Opioid; Female; Humans; Nerve Block; Pain Management; Pain, Postoperative; Pregnancy
PubMed: 31968297
DOI: 10.1016/j.jclinane.2020.109715 -
Anesthesiology Sep 2019Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.
METHODS
Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.
RESULTS
Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of -30.5 mg [-42.2, -18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by -4.7cm · h [-5.1, -4.2] or -1.2cm [-1.3, -1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.
CONCLUSIONS
We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
Topics: Analgesia; Breast Neoplasms; Female; Humans; Nerve Block; Pain, Postoperative; Pectoralis Muscles
PubMed: 31408448
DOI: 10.1097/ALN.0000000000002822